Foot Focus Podiatry

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Arch pain

The arch of your foot is the area on the bottom of your foot (sole) between the ball of the foot (forefoot) and the heel. Arch pain is one of the common concerns related to the foot. This pain usually affects the ball and heel of the foot or can be isolated to the center of the arch. Arch pain can vary and be worse while walking or standing depends on the underlying cause of the pain. Sometimes the pain can be more intense in the morning just after waking up and weight-bearing.

Though arch pain is more common among athletes and runners, it might also worsen for people living sedentary lives.

Deformation and Pain in the Arch of the Foot

The arch of the foot is supported by leg muscles that attach to the foot, intrinsic foot muscles, ligaments, and especially the plantar fascia that extend the length of the foot from the heel to theball of the foot. These structures are basically shock absorbers, but if the strain on these structures becomes too great, they can become strained, inflamed and painful, causing pain in the feetlower legs or knees. The pain is most pronounced when weights are placed on the leg or when the leg is pushed against the next leg. The pain from tension in the arches of the legs can become especially acute after sitting for a long time or waking up in the morning.

Who is Most Susceptible to Arch Tension or Strain?

People with very flat feet or high arches are most susceptible to the condition. Injuries are also common in middle-aged people who have been inactive for a long time before suddenly increasing their physical activity. Injuries are very common in runners. Some examples of arch pain are plantar fasciitis, posterior tibialis tendonitis, posterior tibialis dysfunction, and stress fractures.

How Do you Treat Arch Pain?

The most effective treatment for arch pain and tension is the use of orthotics (arch supports). Orthotics help prevent the arches from collapsing by distributing forces, thus preventing the arch from straining causing pain and discomfort. Relevant stretching or strength exercises and supportive footwear can also help prevent morning pain when the symptoms are most common and severe.

How to Prevent Arch Pain?

To avoid arch pain, it is important that you slowly build up your exercise routine while wearing orthotics. By taking these simple measures, you can prevent the discomfort of pain in the arch that can last for months. Low impact exercises such as swimming or aqua aerobics are good alternative exercises to do while your symptoms improve.

  • Winograd procedure- This procedure will be done in hospital setting under local and or general anaesthesia and it is reserved upon failure of the phenolization or if there is significant amount of skin overlapping the nail with soft tissue growth. This procedure involves removing a portion of the skin along with the nail down to the level of the bone. Sutures (stitches) will be applied to close the surgical site. The procedure takes about 10-15 minutes to be performed and your foot will be bandaged. You will be seen within first 5 days and then the sutures will be removed in 10-14 days. Currently this procedure can only be performed by Reza Naraghi (podiatric surgeon).  He will prescribe appropriate pain medication for your post-operative pain management. You will be in open sandal and or post op shoe for 2 weeks. This is not for everyone (especially if you don’t like seeing surgical procedures) but should you be keen to see a step by step process involved in a Winograd then please click here.
  • Zadik Procedure- This procedure is used with permanent total nail removal is desired. The indications for the procedure are significant ingrowing nail on both borders, thickened and painful nails and bony growth under the nailbed. This procedure can be done under local with sedation and or under general anaesthesia at a hospital and or day surgery centre. Sutures will be applied and will be removed 14 days post surgery. You can not get your foot wet and your foot will be in a sterile bandage for 2-3 weeks. You may need pain medication post surgery. On average it will take six weeks for your nail bed area to heal. Following that you can wear most close shoes.

Matrixectomy with phenolization- This procedure involves removing the nail partially or totally and ablating (destroying) the root using a weak acid called phenol. This will cause permanent ablation of the root of the offending nail and prevent ingrown nail recurrence. This procedure is successful 95% of the time. The procedure takes about 10-15 minutes and can be performed in our rooms using local anaesthesia with or without sedation. Post operatively you will be required to soak your toe and apply a daily dressing. Wearing open toe shoes for at least 3-4 days is recommended. You maybe required to take oral antibiotics. Most patients do not require pain medication following the procedure, and if needed Panadol is sufficient for pain management. You can go back to regular shoes after one week.  This is not for everyone (especially if you don’t like seeing surgical procedures) but should you be keen to see a step by step process involved in a partial nail matrixectomy with phenolisation then please click here.